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The changing mortality of myocardial revascularization: coronary artery bypass and angioplasty
K S Naunheim1, A C Fiore, J J Wadley
1Department of Surgery, St. Louis University Medical Center, MO 63104.
Insights
Coronary artery bypass grafting (CABG) saw increased risk factors and doubled mortality by 1985. Percutaneous transluminal coronary angioplasty (PTCA) shifted sicker patients to CABG, impacting outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Health Services Research
Background:
- Coronary artery bypass grafting (CABG) outcomes have evolved over time.
- The advent of percutaneous transluminal coronary angioplasty (PTCA) has altered patient selection for CABG.
Purpose of the Study:
- To compare risk factors and outcomes for CABG in 1985 versus 1975.
- To evaluate the impact of PTCA on the CABG patient population in 1985.
Main Methods:
- Retrospective analysis of the first 150 patients undergoing CABG in 1985 (CABG '85).
- Comparison of CABG '85 cohort with CABG in 1975 (CABG '75) and PTCA in 1985 (PTCA '85).
- Assessment of operative risk factors and overall mortality.
Main Results:
- CABG '85 patients exhibited significantly higher operative risk factors than CABG '75 patients.
- PTCA '85 patients presented a low-risk clinical profile, similar to CABG '75 patients.
- Overall CABG mortality more than doubled between 1975 and 1985 (3% vs. 7%).
Conclusions:
- Increased CABG mortality in 1985 is partly due to the inclusion of higher-risk patients.
- PTCA diverts lower-risk patients, increasing the complexity of the remaining CABG surgical pool.
- The shift in patient profiles impacts the overall clinical status of patients referred for CABG.
Abstract:
The risk factors and outcome for the first 150 consecutive patients undergoing coronary artery bypass grafting (CABG) in 1985 (CABG '85) were compared with those of the first 150 patients undergoing CABG in 1975 (CABG '75) and those of the first 150 patients to have percutaneous transluminal coronary angioplasty (PTCA) in 1985 (PTCA '85). The CABG '85 patients had a significantly higher (p less than 0.05) incidence of known operative risk factors including advanced age, female sex, severity of angina, history of recent infarction, triple-vessel disease, left ventricular dysfunction, and emergency operation than the CABG '75 cohort. The clinical profile of the PTCA '85 patients closely resembled the low-risk profile found in the CABG '75 patients. Overall mortality following CABG more than doubled during the decade studied (3% versus 7%, p = 0.07). This study suggests that the increased mortality associated with CABG in 1985 is due in part to the inclusion of more high-risk patients in the surgical population. In addition, the application of PTCA removes low-risk patients from the surgical candidate pool and adds more patients requiring emergency operations, thereby further contributing to the overall decline in the clinical status of patients referred for operation.